Introduction
Many of us become more forgetful as we get
older. Some of us will begin to develop more serious problems which
may be the first signs of dementia or Alzheimer’s disease.
This leaflet discusses the possible causes of poor memory and how
to seek help if you are concerned about your own memory or someone
else’s.
What is dementia?
Dementia often starts off with just memory
problems. But it is a condition which affects a large
part of the brainand
can lead to a wide range of problems. These can include:
- difficulty managing day to day tasks
- difficulty communicating
- changes in mood, judgement or
personality
It usually gets worse over time.People with
dementia become increasingly dependent on others to help them as
the illness progresses.
How common is dementia?
Dementia is more common in older people, but sometimes it can
start in people as young as 40. About 5% of people over 65
have dementia and by the age of 80 about 20% (1 in 5) will have
some degree of dementia.
What causes dementia?
Alzheimer’s disease is the
most common cause of dementia. In this condition, damaged
tissue seems to build up in the brain to form deposits called
‘plaques’ and ‘tangles’. These cause the brain cells around them to
die. The disease also affects the chemicals in the brain
which transmit messages from one cell to another. The
chemical most affected is acetylcholine.
Alzheimer’s disease comes on gradually and
develops slowly over several years. We don’t know what causes
Alzheimer’s, but it can sometimes run in families and people with
Down’s syndrome are more likely to suffer from it.
- People with Alzheimer’s disease have problems
with their memory and thinking.
- Learning new information can become very
difficult.
- They may not remember recent events,
appointments or phone messages.
- They may forget the names of people or
places. This can lead to problems with even simple daily
activities.
- They may struggle to understand or
communicate with others.
- A common problem is that they have difficulty
finding the right word for everyday objects or the names of people
they know well. This can lead to frustration and
depression.
- Sometimes they will accuse people of taking
things when really they have lost them.
- Sometimes people with dementia do not feel
there is anything wrong with them. They may become cross when
people try to help. Carers often comment that people with
Alzheimer’s show subtle changes to their personality. For
example they might behave or react differently to how they did
before they became ill.
Vascular dementia - this is
usually caused by the arteries supplying blood to the brain
becoming furred up. This can lead to small strokes or parts
of the brain dying as they are starved of oxygen. This
dementia can sometimes come on more quickly than Alzheimer’s.
People with vascular dementia are more likely to suffer from
conditions which lead to blocked arteries such as high blood
pressure, smoking, diabetes or high cholesterol.
It is difficult to predict the progression of
vascular dementia. It may be stable for several months or
years, but then more strokes can occur which lead to further
deterioration.
The problems caused by vascular dementia will
depend on which part of the brain is affected.
- There may be memory loss and difficulty
concentrating.
- Word finding difficulties are common as they
are in Alzheimer’s.
- It is common to suffer from mood swings or to
feel depressed.
- Some people have episodes of confusion and
may be aggressive or distressed.
- Others may experience hallucinations (where
they see something that is not there).
- Sometimes there are physical problems, for
example difficulties with walking or incontinence.
It is possible for people to have a
combination of vascular and Alzheimer’s dementia. It is often
very difficult even for doctors to tell the difference between
these conditions. A brain scan can sometimes help.
Lewy body dementia - this
form of dementia seems to be caused by Lewy bodies (protein
deposits) building up in the brain.
People with Lewy body dementia may have
symptoms which overlap with Alzheimer’s disease and Parkinson’s
disease. It is likely to get worse over time.
- People have memory problems and difficulty
planning tasks.
- The level of confusion can vary during the
course of the day.
- Many people experience vivid visual
hallucinations of people or animals.
- They may also have a tremor, muscle
stiffness, falls or difficulty with walking.
Fronto-temporal dementia -
this term is used when the dementia seems to affect the front of
the brain more than other areas. This often starts in people
in their 50s and 60s. Because it affects the front of the
brain, it is more likely to cause personality changes as well as
memory problems. So a person who is usually very polite and proper
might start to become irritable or rude to visitors.
Other causes of dementia
There are many other illnesses that could lead
to dementia or memory problems. Some are reversible with the
right treatment. Depression can cause symptoms like dementia
but can be treated with antidepressants
and talking therapy.
Severe anxiety can affect memory and
concentration, but this can be helped with the right treatment and
reassurance.
Many physical
illnesses can cause memory problems.These include kidney, liver
or thyroid problems. Shortage of certain vitamins can cause
dementia, but this is rare. Chest infections or urine
infections can lead to confusion. These can be treated with
antibiotics. There are also much rarer conditions, such as
Huntington’s disease, which can cause dementia in younger
people.
What is Mild Cognitive Impairment?
Many of us worry about our memory. Sometimes
the problem is more than we would expect for our age, but not
severe enough to be called dementia. This is sometimes called
Mild Cognitive Impairment. A number of people (around 5%)
with this problem may eventually go on to develop dementia. We
cannot as yet predict who these people will be.
Getting help
If you are worried about your memory, make an
appointment to see your GP. They may do some simple tests to
check your memory and perhaps organise some blood tests. If
needed they can refer to you a specialist team, a psychologist or a
specialist doctor. These people can carry out more detailed
tests and arrange a brain scan if needed. Some areas run memory
clinics where these assessments are carried out.
Simple practical steps
If you have memory problems there are some
simple practical steps you can take.
- Use a diary to help you remember appointments.
- Make lists.
- Keep your mind active by reading or doing crossword puzzles,
Sudoku’s and other mind exercises .
- Take physical exercise (it can help
whatever your age)
- Eat a healthy diet (supplements such as Vitamin E and Ginkgo
Biloba are not currently recommended).
Treatment
This will depend on the diagnosis and your
circumstances. Unfortunately there are no cures for these
conditions.
There is a group of drugs called acetyl
cholinesterase inhibitors. These may slow the progression of
Alzheimer’s dementia. These drugs
may also be helpful in Lewy Body dementia particularly if
hallucinations are a problem.
In Vascular dementia it can be helpful to take
a small dose of aspirin to prevent you having further strokes.
Your GP may also suggest you take medication if you have high
blood pressure or raised cholesterol. It is also important stop
smoking, eat healthily and take exercise.
Planning for the future
- Discuss any concerns you have with your
doctor, mental health nurse or social worker.
- Charities such as the Alzheimer’s Society are
also a very useful source of advice.
- A mental health nurse can help you understand
more about the illness. They can give advice about medication
and other help available.
- Social services can help with home helps,
meals on wheelsor
day care. You may be entitled to benefits.
- You may also wish to complete a Lasting Power
of Attorney. This means someone you trust can look after your
affairs when you become unable to do this yourself.
The following sources were used to
compile this information
Further reading
Drug treatment of
Alzheimer’s disease. A free factsheet from the Royal College
of Psychiatrists.
Alzheimer's and Other Dementias: answers
at your fingertips. Cayton, Graham, & Warner. Class
Publishing (London) Ltd. 3rd edition 2008.
Your Memory: a users guide. Baddeley.
Carlton Books (London). Revised edition 2004.
Dancing with Dementia: My story of living
positively with dementia. Bryden. Jessica Kingsley
Publishers (London & Philadelphia). 2005.
Helpful organisations
Alzheimer’s
Society
Devon House, 58 St Katherine’s Way, London E1W
1JX
Telephone: +44 (0) 20 7423 3500. Helpline:
0845 300 0336
Email: mailto:enquires@alzheimer's.org.uk
The Alzheimer’s Society is a care and research
organisation for people with dementia and their carers. They
have local offices throughout the country and offer support and
advice. You can also obtain helpful fact sheets from your
local office or by downloading them online.
Age
Concern
Astral House, 1268 London Road, London
SW16 4ER
Free helpline: 0800 00 99 66.
Help the Aged
207-221 Pentonville Road, London N1 9UZ
Telephone: 020 7278 1114.
Carers UK
20 Great Dover Street, London SE1 4LX
Telephone: 020 7378 4999. Carers
Line: 0808 808 7777
Carers UK supports for carers who are
providing unpaid care for friends or relatives.
Citizen’s Advice
Bureau
The Citizen’s Advice Bureau offer free,
confidential and independent advice. Contact your local
office for assistance with benefits, financial planning or
organising care.
The Office of the
Public Guardian and the Court of Protection
Archway Tower, 2 Junction Road, London N19
5SZ
Telephone 0845 330 2900 (open 9am – 5pm)
The Office of the Public Guardian can provide
information on making and registering a Lasting Power of
Attorney. Contact them for information about planning for
your own future or supporting someone else who is struggling to
manage their affairs.
This leaflet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms.
Written by: Dr Laura Hill, Specialist Registrar in Psychiatry
& Dr Martin Briscoe, Consultant Psychiatrist, Devon Partnership
Trust.
Last updated: October 2009
Review date: October 2012
© October 2009 Royal College of Psychiatrists.
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